Children’s Dental Health Project | 1020 19 th Street NW, Suite 400 Washington, DC 20036 |...

Children’s Dental Health Project | 1020 19th Street NW, Suite 400 Washington, DC 20036 | 202.833.8288 | www.cdhp.org

Health Reform Implementation – Focus on the States

February 11, 2011

Marcy Frosh Meg Booth & Colin Reusch

Children’s Dental Health Project


Implementation of oral health provisions

• Example of a problem the ACA sought to address?• Status of challenges to the law?• What are the timelines and opportunities around

the state exchanges and the pediatric dental benefit?

• What are some steps states can take to influence the exchange and benefit processes?


The “upside down” problem: Children with most need

have least care

Example of a problem that requires an innovative solution that:


The “fix” : Children with most need

get most care

As the Children’s Dental Health Project (CDHP) sees it:

The challenge is to:

1. Reduce disease burden2. Improved access to quality

care


How federal Health Care Reform can innovate:

• Comprehensive systems approach, building on CHIPRA

• Health coverage bill – estimated by 2019, 92% non-elderly will have health insurance

• Provides dental coverage to nearly all children

• Coverage is supported by numerous additional provisions

• Unfortunately, many of these provisions still await funding

Prevention & Health Promotion

Quality Treatment

Oral Health Infrastructure & Capacity

Community Awareness/Education

Effective Coverage

Family-levelPrevention

Effective

Workforce

Child-level disease management

Effective

Delivery Systems

Surveillance, Evaluation, CQI

Systems Framework


Prevention & Health Promotion

Dental Caries Disease Management

Establishes a national grant program to demonstrate the effectiveness of research-based dental caries disease management

School-based Dental Sealant Programs

Requires that states receive grants for school-based dental sealant programs

Oral Health Public Education Campaign

Requires HHS Secretary to establish a 5-year public education campaign to promote oral health

Prevention and Public Health Trust Fund

Establishes a fund to provide an expanded and sustained national investment in prevention and public health programs – may include oral health

National Prevention, Health Promotion, and Public Health Council

Charged with coordinating Federal prevention policy and developing a national prevention strategic plan

Community Transformation Grants

Establishes grants to state and local agencies and community organizations for prevention efforts outside the doctor’s office


Workforce and Training

Alternative Dental Health Care Providers

Establishes a 15-site demonstration project to train or employ alternative dental health care professionals

National Health Care Workforce Commission

Establishes the Commission and makes the oral health care workforce a high priority for review

Dental Training Programs

Establishes a number of provisions to promote and encourage the training of dental professionals including loan repayment

Primary Care Residency Programs

Establishes three-year, $500,000 grants for new primary care residency programs, including oral health

Graduate Medical Education Programs

Provides funding for new and expanded graduate medical education, including dental education


Delivery System

Federally Qualified Community Health Centers

Provides funding for construction, capital improvements and service expansions, including dental program expansions

School-based Health Centers

Provides Grants to SBHCs and includes oral health services in qualified services provided by SBHCs

Center for Medicare and Medicaid Innovation (CMMI)

Establishes and funds a CMS Center to explore new models of care delivery (coordinated care, medical homes, dual eligibles etc.) and care financing. Opportunities for state demonstration grants available.


Infrastructure, Quality & Surveillance

Oral Health InfrastructureRequires the CDC to provide cooperative agreements to states for improving oral health infrastructure (from 19 states 50 states, territories, & tribes)

Pregnancy Risk Assessment and Monitoring System

Requires that oral health measurements be included in PRAMS

National Health and Nutrition Examination Survey

Retains “tooth-level” surveillance in NHANES

Medical Expenditure Panel Requires a “look-back” validation for dental - parity with medical

National Oral Health Surveillance System

Requires that NOHSS include measurement of early childhood caries and authorizes funding to expand the system to all 50 states


Mandatory ACA Funding

Oral Health Services for Children (Dental Benefit)

Required

Prevention and Public Health Trust Fund 2010 – $500 million, 2011 – $750 million, 2012 – $1 billiion, 2013 – $1.25 billion,2014 – $1.5 billion , 2015 – $2 billion

School-Based Health Centers Capital Program $200 million through 2013 for construction and improvements

Community Health Center Expansion (operations, construction, and improvements)

$11 billion through 2015

Health Insurance Exchanges Amounts necessary to award state planning and establishment grants

Center for Medicare and Medicaid Innovation $15 billion through 2019,


Future of Health Care Reform Law

• Congress: Attempts to repeal & to modify

• U.S. Supreme Court: Does Congress have the power to require people to buy health insurance?

Arguments:-- Yes – within power to regulate interstate commerce, to impose taxes and to pass laws that are necessary and proper to carry out its intentions.

-- No (and whole law is potentially unconstitutional) - exceeds Commerce Clause power to reform and regulate the market


Timeline for Federal Appropriations:

• September 2010: Congress passed a continuing resolution (CR) for FY11 until December 3.

• Senate Appropriations Committee and House Labor HHS Appropriations Subcommittee proposals included oral health, but fell short of full funding

• December 2010: Congress passed 2nd CR for FY11 until December 21.• December 2010: Congress passed 3rd CR for FY11 until March 3, 2011.• Despite lack of funding, Federal government is moving forward with

implementation through regulations & rulemaking, ARRA funding, and shifting money between agencies (e.g. Title VII)


MN not a party to the health reform challenge . . .

Governor Mark Dayton is on record with:• Support for most of the federal health care reform law,

including requirements on allowing individuals with pre-existing conditions to purchase insurance, and is in favor of asking for and accepting most grants and other incentives

• A proposal to create a “health care helpline” to advocate for patients regarding insurers, providing a public option, reducing paperwork, e-prescribing, telehealth, and home-based care


Current State Action: Insurance Exchanges

Key Players:1. National Association of Insurance Commissioners (NAIC)2. Office of Consumer Information and Insurance Oversight

(OCIIO) at HHS

3. State Insurance Commissioners & Departments of Insurance

4. Governors’ Offices & State Health Agencies


State Insurance Exchanges: Timeline

20102014

2011 2012 2013

Fall: Initial guidance released

Exchange planning grants awarded

NAIC Model Legislation released

January: Second round of state planning and establishment grants now available.

January: Exchanges must

be certified by HHS

January: States indicate whether they will operate

an exchange

Winter/Spring: Finals rules on

Exchanges issued

Fall: Exchange rules for public comment

January: State and/or Federal

Exchanges up and running

State Exchange Planning Process

2011 & 2012: Stakeholder engagement, exchange governance decisions, plan selection, rates review, etc.


State Insurance Exchange Planning Grants: MN is one of 2 states with no award but is reportedly

pursuing an expedited application

• Alabama• Arizona• Arkansas• California• Colorado• Connecticut• Delaware• D.C.• Florida• Georgia• Hawaii• Idaho

• Illinois• Indiana• Iowa• Kansas• Kentucky• Louisiana• Maine• Maryland• Massachusetts• Michigan• Mississippi• Missouri

• Montana• Nebraska• Nevada• New Hampshire• New Jersey• New Mexico• New York• North Carolina• North Dakota• Ohio• Oklahoma• Oregon

• Pennsylvania• Rhode Island• South Carolina• South Dakota• Tennessee• Texas• Utah• Vermont• Virginia• Washington• West Virginia• Wisconsin• Wyoming

Award details available at: www.healthcare.gov/news/factsheets/grantawardslist.html


Oral health on the radar screen

Approaches to consider:1) Advocate to include oral health in exchange planning

application (indication that the establishment grants should be adequate to accomplish well-developed proposals)

2) Ensure capacity to address oral health in new benefit structure

3) Emphasis state capacity needs to integrate oral health into a plan for seamless interface among Medicaid, CHIP, and the new ACA provisions


Connect with State Insurance Authorities

Defining stakeholder input with or without aplanning grant:

1. Who are interested stakeholders both within oral health and beyond? How can you partner?

2. What are the opportunities for stakeholder input (e.g., consumer protections, ensuring viable provider networks, plan options, etc?)


Benefit Design: Timeline

20102014

2011 2012 2013

Fall: DOL begins review of employer benefits

January: IOM public meeting on determination of essential benefits study

January: State and/or Federal Exchanges up

and running with Essential Benefits

Packages and Qualified Health

Plans

March-Sept: IOM study recommendations on essential benefits published

March: DOL report on employer plans released

Fall: Determination of Essential Benefits by HHS

IOM Ongoing Review of Essential Benefits


At the national level, CDHP is working on:

1. Ensuring Medicaid & CHIP access and stability2. Getting the lay of the land (e.g., timelines, champions for

individual provisions), etc.)3. Stakeholder input: 70 organizations signed on to a May

2010 letter requesting funding for the ACA oral health provisions

4. Engaging in determination of benefit design (e.g., that the law’s “essential benefit” for oral pediatric services is defined by medical necessity)

5. Awareness & influence consumer protections


Quick Recap!

Health Care Reform at the moment:

• State insurance Commissioners have power w/ consumer protections, networks, & plan options!

• Messages on Medicaid/CHIP dental benefit need to be reinforced!

• Federal funding for the ACA oral health provisions is key!


Resources

• ACA Summary and Talking Points, CDHP Healthcare Reform Center: www.cdhp.org/cdhp_healthcare_reform_center

• Sample correspondence concerning ACA rules & regulations: www.cdhp.org/cdhp_healthcare_reform_center

• Comment on Rules and Regs, Office of Consumer Information & Insurance Oversight www.hhs.gov/ociio

• NAIC Model Exchange Legislation: www.naic.org/documents/committees_b_exchanges_adopted_health_benefit_exchanges.pdf

• IOM Essential Health Benefits Survey Results: www.nami.org/Content/ContentGroups/Policy/Issues_Spotlights/Health_Reform/NAMICommentsIOM1210.pdf

Visit the CDHP website at: www.cdhp.org


Thank You!

Visit the Children’s Dental Health Projectat: www.cdhp.org

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